Organization
ERIC R NISENSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC R NISENSON (SOLE PROPRIETOR)
(802) 362-9959
Entity
Organization
Contact information
Practice address
7252 MAIN STREET, MANCHESTER CENTER, VT 05255
(802) 362-9959
Mailing address
PO BOX 845, MANCHESTER, VT 05254-0845
(802) 362-9959
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0560000179
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1012914
MEDICAID DME
VT
Enumeration date
05/21/2008
Last updated
06/22/2011
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